9. Claim Number: Each inpatient claim made to your Medicare account is assigned a claim number. If, for instance, you were hospitalized for three days, all billed services and supplies relating to that visit would have the same claim number.
10. Hospital: This is the hospital where you received treatment. If you did not receive services or supplies from this hospital, contact the hospital billing office directly. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, contact Medicare at 800-MEDICARE (800-633-4227).
11. Referred by: This is the name of the doctor who admitted you to the hospital or facility.
12. Dates of Service: These are the dates you received treatment. If you did not receive services or supplies on these dates, contact the hospital or facility billing office. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).
13. Facility: This is the name and address of the skilled nursing or hospice facility where you received care. It may also be the name of the company that provided home health care. If you did not receive services or supplies from this facility or company, contact the facility or company billing office directly. If the billing office cannot resolve your concerns, contact your customer service company (see pop-up No. 4). If you still have concerns, call Medicare at 800-MEDICARE (800-633-4227).
14. Benefit Days Used: A "benefit period" begins on the day you are admitted to the hospital, hospice or skilled nursing facility and ends when you have been out for 60 days in a row. Benefit periods matter because you pay an out-of-pocket deductible ($1,132 in 2011) each time you enter a new benefit period. This column indicates the number of days you have been in your benefit period. The example on this sample Medicare Summary Notice shows that 25 of the 60 benefit days have been used for back-to-back inpatient stays at two facilities.
If you are readmitted to a hospital or facility before you've been out for 60 days, you will continue in the "old" benefit period.
If you are admitted again after you have been out for at least 60 days, you begin a new benefit period and will pay another out-of-pocket deductible.
15. Noncovered Charges: Medicare doesn't cover all of your medical expenses. For example, Medicare does not pay for the first three units of blood used in a transfusion, nor does it cover copies of X-rays, or the charge for a television or telephone in your hospital room. The dollar amounts in this column are the part of the hospital's or facility's claim that Medicare did not pay. (For more about noncovered charges, see "What Medicare Doesn't Cover." To challenge an unpaid charge, see "Appealing a Medicare Claim Decision.")
16. Deductible and Coinsurance: Each of your hospital benefit periods has an out-of-pocket deductible. (See pop-up No. 14 for more about "benefit periods.") You must pay the deductible amount ($1,132 in 2011) to the hospital or facility before Medicare pays on the claim.
This section shows the amount that has been applied to your insurance deductible, and/or to your coinsurance. (Coinsurance is a percentage of a charge that you pay out-of-pocket. For instance, Medicare might cover 80 percent of a charge and require you to pay the remaining 20 percent.)
This sample Medicare Summary Notice shows that the $1,132 deductible has been met and the patient must pay that amount to the hospital.
Also, keep in mind that depending on the services you receive, you might also need to pay an out-of-pocket co-payment, or fixed fee. For example, this could be the $10 or $20 you pay at the front desk in your doctor's office.